Can routine outpatient follow-up of patients with bladder cancer be improved? A multicenter prospective observational assessment of blue light flexible cystoscopy and fulguration

Figures & data

Table 1 Demographics and characteristics of consenting patients enrolled in the study

Demographics and characteristics	Uppsala	Malmö	Bærum	Overall
Patients undergoing blue light flexible cystoscopy, n	22	22	25	69
Cancer stage at original diagnosis, n
Ta	12	7	22a	41a
T1	8	10	2	20
Carcinoma in situ	2	2	2a	6a
Positive cytology	0	3	0	3
Cancer grade at original diagnosis (World Health Organization 1973 grading system), n
1	6	3	9	18
2	6	4	8	18
3	10	15	8	33
Risk group for recurrence, n
High	16	15	16	47
Intermediate	2	4	1	7
Low	4	3	8	15
Previous intravesical treatment, n
Bacillus Calmette–Guérin	13	14	10	37
Mitomycin C	5	3	0	8
None	4	5	15	24
Mean time since diagnosis of bladder cancer, years	12	4	8	8
Mean previous cystoscopies, n	8.9	8.0	14.7	10.8
Mean previous transurethral resections of the bladder, n	3.4	1.7	3.2	2.8

Note:

a Includes one patient with concomitant Ta and carcinoma in situ.

Table 2 Logistics of blue light flexible cystoscopy

Parameter	Uppsala	Malmöa	Bærum	Totala
Time required per patient for preparation and instillation of hexaminolevulinate, n
≤10 minutes	16	22	19	57
>10–≤15 minutes	6	0	5	11
>15–≤20 minutes	0	0	1	1
Total waiting time per patient between HAL instillation and cystoscopy, minutes	59	55	60	59
Cystoscopy time, n
≤5 minutes	1	6	6	13
>5–≤10 minutes	14	14	8	36
>10–≤15 minutes	8	2	11	21
Patients per hour	2	2	2	2

Note:

a Includes one patient who had blue light flexible cystoscopy twice.

Abbreviation: HAL, hexaminolevulinate.

Figure 1 Cystoscopic appearance of bladder tumors under white light (left) and blue light (right). Images are from a 75-year-old man with a 4-year history of bladder cancer (most serious diagnosis Ta grade 1), who was found to have carcinoma in situ on follow-up flexible cystoscopy that was clearly visible under blue light. Image credit: Reza Zare, MD, Urologist, Head of Urology Department, Bærum Hospital Vestre Viken HF, Oslo, Norway.

Table 3 Detection and management of recurrent tumors in the current study

Parameter		Uppsala	Malmö	Bærum	Total
Patients with malignant lesions identified in this study, n
Any stage	BLFC	5	6	3	14
	WLFC	4	5	2	11
Ta lesions	BLFC	3	2	2	7
	WLFC	2	2	1	5
T1 lesions	BLFC	1	2	0	3
	WLFC	1	2	0	3
Carcinoma in situ	BLFC	1	2	1	4
	WLFC	1	1	1	3
Management of detected lesions, n
Fulguration		5	4	2	11
Referral for TURB		0	2	1	3

Abbreviations: BLFC, blue light flexible cystoscopy; TURB, transurethral resection of the bladder; WLFC, white light flexible cystoscopy.